Our Model

Is Your Elder At Risk? – PHQ9

1. Are you filling out this questionnaire for yourself or for a family member, relative, or friend?
2. Where do you or your family member, relative, or friend reside in?
3. What is your age or the age of your family member, relative, or friend?
Over the past 2 weeks, how often have been bothered by any of the following problems?
Little interest or pleasure in doing things?
Feeling down, depressed or hopeless?
Thoughts that you would be better off dead or of hurting yourself in some way?
Over the past 2 weeks, how often have been bothered by any of the following problems?
Trouble falling asleep, staying asleep, or sleeping too much?
Feeling tired or having little energy?
Poor appetite or overeating?
Feeling bad about yourself – or that you’re a failure or have let yourself or your family down?
Trouble concentrating on things, such as reading the newspaper or watching television?
Moving or speaking so slowly that other people could have noticed. Or, the opposite – being so fidgety or restless that you have been moving around a lot more than usual?
Do currently have or have had any of the following?
Diagnosed depression
Diagnosed anxiety
Widowhood within recent two years
Frequent Self-blame/ feeling bad about self
Chronic pain
Lives alone
Less than one social interaction daily
Often feels lonely

If you would like a record of the results of this questionnaire, please provide your e-mail address.
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